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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002828
Report Date: 06/25/2024
Date Signed: 06/25/2024 02:20:09 PM

Document Has Been Signed on 06/25/2024 02:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SUNRISE SENIOR CAREFACILITY NUMBER:
345002828
ADMINISTRATOR/
DIRECTOR:		HEYDON, ANITAFACILITY TYPE:
740
ADDRESS:6729 SUGAR MAPLE WAYTELEPHONE:
(916) 745-4167
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 4DATE:
06/25/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Steve Heydon, Administrator Designee TIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection. LPA met with Steve Heydon, Administrator Designee, and stated the reason for the inspection.
LPA was advised there are (4) resident currently, and (1) resident moved in yesterday.

During today's inspection, LPA obtained copies of documentation from each resident's file.

LPA and Administrator Designee toured the facility and observed (4) residents to be resting in their rooms. LPA observed (2) health care representatives to be talking with resident (R1) in resident's room.

LPA discussed Regulation 87507/Admission Agreements and how one should be signed within (7) days of resident moving in.

There are no deficiencies issued in today's report.

Exit interview. Copy of report provided to the Administrator Designee.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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